Provider Demographics
NPI:1306494893
Name:BLONG, PAIGE I (PA)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:I
Last Name:BLONG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:
Other - Last Name:MUEHLHAUSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1951
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:680 PILLSBURY ST N
Practice Address - Street 2:
Practice Address - City:PILLAGER
Practice Address - State:MN
Practice Address - Zip Code:56473-2507
Practice Address - Country:US
Practice Address - Phone:218-746-4527
Practice Address - Fax:218-746-4528
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13144363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant